Clinical Nutrition For Pharmacists

Question 1

List 3 ways to decrease the risk of cardiovascular disease

Answer 1

1. Increase omega-3 fatty acid intake e.g. oily fish
2. Reduce saturated fat intake e.g. processed meat, dairy
3. Antioxidant supplementation e.g. cranberry juice

Question 2

Name the mineral that causes hypertension

Answer 2

Sodium, Na+

Question 3

What effect does calcium supplementation have on BP?

Answer 3

Small decrease in BP, however a reduction in salt has a greater effect

Question 4

How is BMI calculated?

Answer 4

weight/(height^2) kg/m^2

Question 5

List 3 groups which would BMI would be unhelpful for

Answer 5

1. Elderly
2. Children
3. Athletes/bodybuilders

Question 6

When should the patient be referred to their GP with regards to their weight?

Answer 6

If they are underweight or obese class 2 or 3

Question 7

Define: Malnutrition

Answer 7

A state of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue or body form

Question 8

When does malnutrition occur?

Answer 8

When diet is insufficient to meet the demands of the body

Question 9

Define: MUST score

Answer 9

Malnutrition Universal Screening Tool

Indicates risk of malnutrition, completed for all hospital admissions

Question 10

List the 5 steps of the MUST score

Answer 10

1. Height and weight for BMI
2. Note unplanned weight loss and score
3. Establish acute disease score
4. Add scores from steps 1-3 for complete score
5. Use management guidelines or local policies to create action plan

Question 11

List 2 criteria of malnutrition according to NICE

Answer 11

1. BMI of less than 18.5 kg/m2
2. Unintentional weight loss greater than 10% within the last 3-6 months

Question 12

List the 3 stages of starvation

Answer 12

1. Glycogenolytic
2. Gluconeogenic
3. Ketogenic

Question 13

Describe the glycogenolytic stage of starvation

Answer 13

1. Glycogen stores in the liver and muscle used up in 24 hours
2. Fall in blood glucose
3. Increase in glucagon

Question 14

Describe the gluconeogenic stage of starvation

Answer 14

1. Fall in insulin
2. Protein breakdown (lean tissue) releases amino acids for glucose production

Question 15

Describe the ketogenic stage of starvation

Answer 15

1. Lipolysis releases free fatty acids and glycerol from adipose tissue
2. Glycerol converted to glucose by liver and kidneys
3. Free fatty acids converted to ketones by liver

Question 16

Define: Refeeding syndrome

Answer 16

When a person in a state of prolonged starvation is given nutrition which causes serious complications

Question 17

Why can refeeding syndrome cause serious complications?

Answer 17

• Sudden shift in energy source and insulin secretion when person starts to eat
• Glycogen, fat and protein synthesis begins which requires phosphate, magnesium and thiamine
• Increased absorption of potassium and magnesium into cells
• This leads to a decrease in serum levels of K⁺, PO₄^- and Mg²⁺

Question 18

List 4 symptoms of refeeding syndrome

Answer 18

1. Cardiac failure
2. Hypotension
3. Coma
4. Seizures

Question 19

Which 4 minerals should be checked for their levels before re-feeding?

Answer 19

1. Potassium
2. Calcium
3. Phosphate
4. Magnesium

Question 20

Name an alternative route for re-feeding

Answer 20

Parenteral (nutrition)

Question 21

Why is parenteral nutrition sometimes used for re-feeding?

Answer 21

• Non-functional, inaccessible or perforated (leaking) GI tract
• It is a complete mixture of all nutrients

Question 22

List 3 risks of providing nutrition via the parenteral route

Answer 22

1. Infection
2. Liver abnormalities
3. Fluid abnormalities

Question 23

List 3 pieces of dietary advice for diabetics

Answer 23

1. Manage body weight
2. Treat and prevent dyslipidaemia
3. Treat and prevent hypertension

Question 24

Who are coelicas?

Answer 24

Gluten intolerant

Question 25

What does ingestion of gluten lead to in coeliacs?

Answer 25

Intestinal atrophy - malabsorption

Question 26

List 3 symptoms of coeliac disease

Answer 26

1. Weight loss
2. Fatigue
3. Diarrhoea